Individual
NICKOLAS BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 US HIGHWAY 61, FESTUS, MO 63028-4100
(636) 933-5337
Mailing address
1400 US HIGHWAY 61 STE H1521, FESTUS, MO 63028-4100
(636) 933-5337
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2024001495
MO
Other
Enumeration date
06/17/2021
Last updated
08/05/2024
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